- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.97 / $250.71 / $487.61
| Professional | | $213.97 | $250.71 | $487.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.22 / $401.22 / $401.22
| Professional | | $401.22 | $401.22 | $401.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.44 / $507.37 / $917.30
| Facility | | $140.44 | $507.37 | $917.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.11 / $468.15 / $637.86
| Professional | | $351.11 | $468.15 | $637.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.73 / $315.73 / $315.73
| Facility | | $315.73 | $315.73 | $315.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.48 / $230.48 / $630.00
| Professional | | $230.48 | $230.48 | $630.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.44 / $362.95 / $2,210.04
| Facility | | $134.44 | $362.95 | $2,210.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.03 / $208.25 / $313.70
| Professional | | $188.03 | $208.25 | $313.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $243.26 / $243.26 / $243.26
| Facility | | $243.26 | $243.26 | $243.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.22 / $208.25 / $313.70
| Professional | | $188.22 | $208.25 | $313.70 |